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How can we ensure more adolescents stick to treatment regimens?

Helen McDowell

Natella Rakhmanina

A fast track programme and peer counselors are helping more adolescents to start and stick to their treatment regimens in Kenya.

Lack of widespread education, combined with cultural and religious barriers, mean HIV/AIDS is still a taboo in many communities, discouraging people aged between 10 to 19 from seeking tests and, if necessary, treatment.

Systems of support tailored to teenage life

Helen McDowell is responsible for ViiV Healthcare’s corporate social responsibility programme, Positive Action for Adolescents. Helen points out that this age group is at that stage of life when they are likely to begin striving for more independence and becoming curious about sex. They may be engaging in behaviour that could increase their risk of contracting HIV, yet they are not receiving guidance in avoiding the virus or may not be receiving treatment if they have the virus.

They are embarrassed about talking to parents about their curiosity around sex – and possibly drugs.

“There are barriers to young people – all over the world – talking about a condition that has a stigma attached to it,” she says.

“Adolescents are at a vulnerable stage in their lives when they are embarrassed about talking to parents about their curiosity around sex – and possibly drugs – and so we have a lack of education about the risk factors for contracting HIV.”

Encouraging young people to brave the stigma attached to HIV in many communities is vital. In Kenya, according to Ministry of Health, more than half of all new cases diagnosed were among people aged 15 to 24 in 2015.

Natella Rakhmanina, Senior Technical Advisor at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), says “My heart breaks when I see an adolescent present with advanced HIV symptoms because it’s often too late for us to be able to offer as much effective help as if they’d sought a diagnosis and treatment earlier.”

photo credit: Elizabeth Glaser Pediatric AIDS Foundation

Peer support, without judgment, is crucial

McDowell points out that, even if an adolescent can talk to an adult family member about being taken for an HIV test, there are still major obstacles to them staying on a treatment plan.

“There is a lot of work that needs to be done to build healthcare systems that cater for adolescents because they’re clearly not children, but they’re not adults either,” she says.

“It’s not only a case of breaking down the stigma but also some fairly straightforward things, such as offering clinics for their age group that are timed to fit in with school and educating healthcare staff to be non-judgemental about younger teenagers who may have contracted the condition through sex is also crucial.

“One of the key tools in keeping adolescents on treatment programmes is offering someone of their own age they can talk to and confide in.”

The first signs have been promising

With support from ViiV Healthcare’s Positive Action for Adolescents Programme, EGPAF began spearheading a project that seeks to overcome many of the hurdles in linking newly-diagnosed HIV-positive adolescents and young people with care and treatment programmes and support. The Red Carpet Programme (RCP) times services around school hours and educates healthcare staff to be friendly and non-judgemental. It works with boarding and secondary schools to train students and school staff as counsellors in whom their peers living with HIV can confide and find support.

The Red Carpet Programme times services around school hours and educates healthcare staff to be friendly and non-judgemental.

“It’s important to educate people and break down the taboos. Then, if a young person receives a positive diagnosis, we give them a VIP card,” Rakhmanina says. “It’s a way of introducing them to a more positive experience, and it enrols them on a fast track process that will get them seen as soon as possible by a doctor. We try to keep prescheduled appointments to a minimum and they’re always offered around times that fit in with an adolescent’s schooling.

“We have young advocates who are available to talk to these young people and offer support frequently, particularly right after they have had a positive test for HIV.”

The first results from the pilot RCP programme in Kenya’s Homa Bay and Turkana counties are encouraging. Previously, among those aged 15 to 21, only 66 per cent of adolescents initiated on antiretroviral therapy were still in treatment after three months; after six months, just 54 per cent. Under the RCP, retention in care rates have risen to 90 percent at three months and nearly 99 per cent at six months.

The challenge now is to see if this progress can be maintained and scaled up in other areas with high rates of adolescent HIV epidemic.

photo credit: Elizabeth Glaser Pediatric AIDS Foundation

Listening and adapting is key

Through talking to adolescents and understanding what type of healthcare changes they would like to see, healthcare systems can design clinics, services and treatment plans that are built around what young people want, not what adults presume is apt.

This can have a major, positive impact on encouraging young people to return to clinics to see a doctor, continue treatment if they already have the virus and provide education and support to help more young people stay HIV-negative.

Proper drug adherence not only helps adolescents stay healthy, but also guards against the virus becoming drug-resistant, –helping current medicines to stay effective for longer.